This dissertation uses the methods of social history to examine the variables-political, social, economic, and medical--that shaped alcohol problems and their treatment in late 19th- and early 20th-century America: the period in which American society first defined alcohol abuse, or what was then called inebriety, as a significant social and medical problem. The study begins with the formation of the American Association for the Cure of Inebriety in 1870 and ends in 1919 with Prohibition. These years witnessed the development of extensive networks of care for inebriates in the United States and abroad. Three questions guide this historical inquiry: 1) How were alcohol problems established within the medical domain? 2) How did the new medical understanding and the variation within that understanding promote new health care and social policy? and 3) How and how well did new institutions and organizations for inebriates function? Both health care and social policy are strongly influenced, consciously or not, by history. Policy makers may unconsciously accept fundamental assumptions of the past that are embedded in modern science but have little utility for the present. Though policy makers sometimes refer to the work of academic historians, they often invoke a past more mythic than real to justify their current positions. There is a major gap in historical information on alcoholism and medical strategies used to treat those with alcohol problems. The historical approach taken in this project should 1) reveal the ways in which cultural assumptions about gender, ethnicity, religion, and socioeconomic status influence the diagnosis and treatment (medical and non-medical) of alcohol problems and 2) point to the ways in which current policy reflects assumptions, cultural and medical, that are no longer helpful in shaping effective care for problem drinkers.